Otorhinolaryngologists are usually not keen on taking care of patients with psychosomatic disorders, however their clinical course is greatly affected by psychosocial factors. Most doctors find it difficult to take care of these patients during the limited time spent in the outpatient clinic. In addition, otorhinolaryngologists consider that their specialty does not include the care of patients with psychosomatic disorders, but that it is limited to surgical treatment. Nevertheless, it is reasonable to assume that collaboration with a clinical psychologist specializing in psychological disorders is also required. We conducted a statistical analysis using data from 44 patients who required psychological intervention. Meniere disease was the most frequent diagnosis. Psychological counseling was conducted in all cases, and the average number of counseling sessions was 6.4 ± 6.7 (for a duration of 214.8 ± 162.5 days). The prognosis was improved in 31 patients (70.5%). Collaboration between doctors and clinical psychologists is beneficial, especially to patients for whom administration of the conventional treatment is difficult.

Patients with Ménière's disease who have relapsed following endolymphatic sac surgery (EDS) or intratympanic gentamicin injection are occasionally treated with intratympanic gentamicin injections or revision surgery. However, there is a potential link between Ménière's disease and anxiety or depression. The use of serotonin selective reuptake inhibitors (SSRIs) is likely be beneficial in the treatment of patients with Ménière's disease. The aim of this report is to describe the benefits of SSRIs in patients with relapsed Meniere's disease. Over the course of two years, three patients were treated for symptoms associated with Ménière's disease with an SSRI (sertraline), with the complete resolution, or significant improvement, of symptoms. In these cases, the SSRI may have treated the associated morbidity and not Ménière's disease itself. Ménière's disease that appears to be resistant to typical otological treatment may not be just Ménière's disease. Ménière's disease may co-exist with three other conditions that are able to cause vestibular symptoms and respond to SSRIs: migraine-associated vertigo (MAV), panic disorders and chronic subjective dizziness (CSD).

Isolated cortical vein thrombosis (ICVT) is extremely rare. Only single case or small series of ICVT have been reported; clinical details are still uncertain. We report a case of isolated superficial sylvian vein thrombosis with exceedingly long cord sign. A 14-year-old female with severe sudden onset headache visited our hospital. Fluid attenuated inversion recovery and echo-planar T2* susceptibility-weighted imaging (T2*SW) showed a long cord sign on the surface of the sylvian fissure. The patency of dural sinuses and deep cerebral veins were confirmed by magnetic resonance venography (MRV), and diagnosis of ICVT was made. She recovered completely without anticoagulant agents. To clarify the clinical characteristics of ICVT, we reviewed 51 ICVT cases in the literature. In many cases, T2*SW was the most useful examination to diagnose ICVT. In contrast with general cerebral venous thrombosis, MRV and conventional angiography were either supporting or useless. Anastomotic cortical veins were involved frequently; symptoms of gyri around the veins were common. It also suggested that ICVTs of the silent area might have been overlooked because of nonspecific symptoms, and more patients with ICVT may exist. In cases involving patients with nonspecific symptoms, the possibility of ICVT should be considered.

There are some patients complaining of somatic symptom who has depression. The use of antidepressant to these patients would be quite useful. Patients with dispersion have a variety sort of physical symptom. The evaluation of depression based on physical complaints may be difficult for otorhinolaryngologists, but it is important to do so where possible to increase the focus on the subject's physical illness. The prevalence of somatic complaints in hospitalized patients whose chief complaint was either dizziness or vertigo was very high. These patients were usually accompanied with depression. Then the effect of paroxetine to the patients with tinnitus was investigated. The paroxetine may be effective in treating distressed tinnitus patients with depression and anxiety by reducing their tinnitus severity as well as their depression and anxiety.

Dizziness and psychogenic disorders, including depression and anxiety, are closely related. The diagnosis of dizziness includes not only an evaluation of vestibular dysfunction, but also a psychogenic evaluation. Using this approach, the following three different patterns of dizziness should be carefully identified: psychogenic, otogenic, and interactive. The common somatic symptoms in patients with chronic dizziness (N = 145) were investigated using questions designed to assess headache, insomnia, diarrhea, constipation, stomachache, chest pain, palpitations, dyspnea, and general fatigue. The prevalent somatic symptom in patients with dizziness included general fatigue, insomnia, and headache. These symptoms are very similar to those reported for patients with anxiety and depression. Patients with dizziness clearly had several somatic complaints related to anxiety or depression that could be attributed to the dizziness. Treatments included pharmacotherapy and physical therapy (including rehabilitation for vestibular dysfunction), surgical intervention, pharmacotherapy, and psychotherapy for anxiety and depression. Pharmacotherapy using serotonin reuptake inhibitors and psychotherapy, such as autogenic training, were also performed.